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<p>IF CARDIOLOGISTS, ENDOCRINOLOGISTS AND OTHER PHYSICIANS CAN MONITOR PATIENTS REMOTELY, why can&#8217;t orthopedic surgeons performing knee surgeries?</p>
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<p>“We’ve seen the impact remote patient monitoring can have on patient care,” says Liane Teplitsky, president of global robotics and technology and data solutions at MedTech orthopedics firm Zimmer Biomet. “Orthopedics definitely has been behind in this.</p>
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<p>So the Warsaw, Indiana, company joined Canary&nbsp;Medical, a Carlsbad, California, medical data firm, to develop “smart knees.” Formally known as Persona IQ, these artificial knees have built-in sensors to track patients’ post-op recovery.</p>
<p>The U.S.&nbsp;Food and Drug Administration approved the implants in the fall of 2021, and the first were used that October.</p>
<p>Now physicians can remotely monitor medical issues before implant patients report them. They also can have hard numbers versus recipients’ sometimes hazy memories to determine whether recovery is on target— or of concern.</p>
<p>The device measures gait, walking speed, distance, stride length, average steps per minute, number of steps and range of motion—all of which can reveal whether a patient is limping or moving too slowly for their expected stage of post-op recovery, given their age and gender.</p>
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<p>“Those are important parameters to know how well someone is doing,” says Yair Kissin, M.D., orthopedic&nbsp;surgeon and interim chairperson of orthopedic surgery at Hackensack University Medical Center in New Jersey. “It takes knee replacements to the next level.”</p>
<p>Persona IQ&nbsp;smart knees serve as an early warning system, influencing the frequency of physical therapy, lab tests and in-office or telemedical visits, and raising flags for surgical revisions.</p>
<p>“People come from long distances away to my practice,” says Fred Cushner, M.D., an orthopedic surgeon and associate professor at New York’s Hospital for Special Surgery. “I’m more comfortable stretching time between in-office visits if their recovery is on target. And if they’re not doing well, we can intervene earlier than was scheduled.”</p>
<p>Not only is knowledge power, but it also leads to greater patient satisfaction, says Cushner, who’s a Canary Medical founding member and chief surgical officer. “The saying is that the reaction to hip replacements is ‘wow’ and to knee replacements is ‘ow.’ One of our goals is to get more ‘wows.’”</p>
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<p>With the Agency for Healthcare Research and Quality reporting as many as 634,000 knee replacement surgeries yearly — equal to the entire population of Portland, Oregon — the move from “ow” to “wow” could be dramatic.</p>
<p>Many people have used wearable remote monitors, such as watches or braces with sensors. But studies have found that up to half of them aren’t wearing the tools correctly — or at all, Kissin says. “With the smart knee, they can’t leave home without it. It’s 100 percent more reliable.”</p>
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<h2>How it works</h2>
<p>The Persona IQ’s tibial extension, which is named “canturio <em>te</em>,” is as long and wide as an AA&nbsp;battery, Cushner says. Within are an antenna and radio system akin to that in a pacemaker. Sensors use electronics, accelerometers and gyroscopes to track movement, and most data is collected every 20 seconds.</p>
<p>“We measure activity and function to see whether the joint is firmly in place and moving appropriately,” Cushner says.</p>
<p>The information downloads nightly into a bedside base that’s barely larger than a smartphone. It’s also stored in the cloud, where physicians can locate and interpret it.</p>
<p>The Persona IQ&nbsp;also can reassure— and motivate—patients, Cushner says. Zimmer Biomet’s related mymobility patient app enables users to see how they’re doing compared to others of the same age, gender and time since surgery.</p>
<p>“Humans are inherently competitive,” he says. “If they fall behind, they may become more diligent, and if their numbers improve, that’s positive reinforcement.”</p>
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<h2>The future</h2>
<p>Soon, the tibial extension will shrink to the size of an AAA&nbsp;battery, Cushner says.</p>
<p>But the impact of such monitors should grow. Smart hip and shoulder replacements received FDA&nbsp;breakthrough status in mid-2022.</p>
<p>“The more data we collect, the more we can learn,” he says. “Our holy grail would be to diagnose infections or scar tissue.” Other goals are to detect blood clots (DVTs), contracture (arthrofibrosis) and whether a knee implant is properly anchored to the bone.</p>
<p>Yet the first months of monitoring progress post-op are not the end game, Kissin says.</p>
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<p>Even years later, a physician may notice that a patient has stopped being active. The physician then can phone the patient between yearly check-ups and learn if they have redness, swelling or fever.</p>
<p>“Thanks to the smart knee, we may detect that a patient is doing poorly before the patient realizes it’s important for us to know,” he says. “We also may catch an infection early. That’s huge.” •</p>
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Michele Meyer

Smart implant used in knee surgeries

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<h2>Can SkinCure Oncology’s image-guided superficial radiotherapy lead to fewer painful surgeries?</h2>
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<p>Image-guided superficial radiotherapy (IG-SRT) is an alternative to Mohs surgery and SRT without image guidance. SkinCure Oncology says its IG-SRT hardware uses low levels of X-ray energy to kill nonmelanoma skin-cancer cells for nonmelanoma skin cancer treatment.</p>
<p>With&nbsp;IG-SRT, physicians and trained therapists use ultrasound imaging to&nbsp;view the tumor in the SRT&nbsp;procedure.</p>
<p>Practitioners use the images to navigate the procedure and show patients the state of the tumor&nbsp;before and after treatment.</p>
<p>“Without image guidance, the physician and radiation&nbsp;therapist must rely on intuition and experience. They look at the visible tumor on the outside of the skin, and they think about their experience treating similar-looking tumors,” says Steven Scott, chief operations and radiation safety officer at SkinCure Oncology.</p>
<p>Apart from the image guidance technology, says Scott, the practitioners guess at what’s going on under the skin. “Then they give themselves a little extra margin and apply the radiation dose. They’ll likely treat some excess healthy tissue to have a better chance at getting all the cancer cells, but they won’t know for certain because they can’t see what’s going on under the skin,” Scott explains.</p>
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<h2>Image-guided SRT in a skin-cancer medical practice</h2>
<p>Jon R. Ward, M.D., is a board-certified Mohs surgeon and dermatologist practicing at Dermatology Specialists in Panama City, Florida. According to Ward, the practice provides cosmetic and medical services for patients with chronic sun damage and skin cancers. Ward uses the SkinCure Oncology IG-SRT&nbsp;in his practice.</p>
<p>“Before adopting image-guided SRT, we really didn’t have any good alternatives to Mohs surgery,” says Ward. When Ward found IG-SRT, he was searching for a treatment that didn’t expose patients to Mohs fatigue, which happens when patients become exhausted due to the repeated cutting throughout the surgeries, he says.</p>
<p>With IG-SRT, patients escape Mohs fatigue, Ward says. Many first-time skin cancer patients choose it for cosmetic or functional reasons, due to poor health conditions that complicate surgery, or to avoid undergoing surgery, he says.</p>
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<p>Before IG-SRT, the practice scheduled many skin cancer patients three or more weeks out, Ward says. With many of those patients now electing the non-surgical IG- SRT procedure, the wait times for Mohs surgery have dropped to about a week, he says. “For image-guided SRT, we can typically schedule treatment to start within a day or two,” Ward says.</p>
<p>When there is a skin-cancer diagnosis, Ward and his colleagues sit with the patient to discuss treatment options. Patients choosing IG-SRT meet with the radiation therapist, who performs a simulation of the procedure to tailor the treatment plan to the patient’s specific situation, Ward says. Patients come in a few times a week for IG-SRT treatment for several weeks, with a follow-up appointment a month or two after treatment completion, he says. “The actual treatment literally takes only a minute or so, and each office visit runs about 10 to 15 minutes,” Ward says.</p>
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<p>Ward’s patients benefit from short wait times and avoid the cutting, bleeding, pain, stitches and surgical scars that come with Mohs surgery, and the reconstructive surgery that may follow it, Ward says. “Image guidance allows us to see the tumor and adapt the treatment based on tumor response. That’s how we achieve a cure rate comparable to Mohs surgery,” Ward says.</p>
<p>Image guidance also lets patients see their progress from treatment to treatment, Ward says. “Our patients have confidence that the procedure is working because they have visual proof, which brings a sense of relief,” Ward says.</p>
<p>Ward finds IG-SRT relieving, too. “Every Mohs surgeon has moments when they wish they didn’t have to cut,” Ward says. Sometimes, eradicating cancer creates cosmetic defects that are difficult, if not impossible, to correct, he says. “When we’re worried about the potential cosmetic impact on a given patient, it’s a blessing to have image-guided SRT as an option. I sleep better at night knowing my patients and I have options,” Ward says.</p>
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<p>Ward’s favorite feature with the IG-SRT is that its image guidance is built directly into the SRT machine, Ward says. “There’s nothing better than turning the screen to face the patient to show them the before and after ultrasound images, and say to them, see, no more visible signs of cancer,” Ward says. •</p>
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David Geer

Nonmelanoma skin cancer treatment

<h2 style="font-variant-ligatures: normal; font-variant-caps: normal; font-style: normal;">Proximie bridges the geographic gaps between surgical specialists and remote clinicians.</h2>
<p style="font-variant-ligatures: normal; font-variant-caps: normal; font-size: 14px; font-style: normal; font-weight: 400;">ACCORDING TO AN ARTICLE FROM THE NATIONAL INSTITUTES OF HEALTH, travel restrictions from COVID curtailed opportunities for in-person surgical mentoring. A specialist in heart surgery, for example, couldn’t fly some distance to scrub in to assist with a new technique. Telementoring, notes the NIH, can solve challenges like this by enabling guidance from a distance using online tools.</p>
<p style="font-size: 14px;">Barriers to close-proximity surgical collaboration&nbsp;predate the pandemic. It remains challenging to send geographically dispersed surgeons in time for an emergency or time-sensitive procedure.</p>
<p style="font-size: 14px;">Advanced telementoring enables remote surgical collaboration and for surgeons to move from one operation to another without these delays in the future of surgeries. A specialist can participate in one surgery in Lebanon and another in Milan without going anywhere.</p>
<h5 style="font-size: 14px;"><strong style="font-size: 14px;">Breaking geographic barriers</strong></h5>
<p style="font-size: 14px;">In 2016, Nadine Hachach-Haram, m.d., founded Proximie to develop its eponymous surgical telementoring platform. The Proximie web app enables multiple health care practitioners to take part in live procedures globally in operating rooms and cath labs to supplement local care.</p>
<p style="font-size: 14px;">According to Charlie Wilhelm, Proximie’s general manager of the Americas, surgeons access the technology on devices compatible with the Google Chrome or Microsoft Edge, including mobile phones and tablets.</p>
<h5 style="font-size: 14px;"><strong style="font-size: 14px;">Expanding collaborative care</strong></h5>
<p style="font-size: 14px;">Proximie enables audio-video communication with video overlays from imaging and augmented reality (ar) tools. Two-way video allows clinicians to see each other during the procedure; collaborating surgeons can speak with the clinicians in the or via the platform. Remote practitioners can overlay patient scans and X-rays on top of the patient in the operating field while viewing the procedure.</p>
<p style="font-size: 14px;">With Proximie, clinicians can draw over images and video freehand, manipulate ar hands and pointers in the surgical field to illustrate and instruct surgeons inmanual and robotic techniques. They can point to specific surgical tools, circle and outline areas for incisions and sutures, and move overlaid medical images into view topoint and draw over those.</p>
<p style="font-size: 14px;">Using the Proximie web app, health care practitioners can interact in a procedure or assessment remotely and mentor a local clinician through a live operation, visually and intuitively, says Wilhelm.</p>
<p style="font-size: 14px;">The telementoring technology displays up to four concurrent live video feeds from medical devices, cameras and wearables using picture- in-picture technology. Compatible input technologies include room cameras, webcams, surgical robotics, scopes, ECG, ultrasound and other&nbsp;devices with video outputs.</p>
<p style="font-size: 14px;">The app integrates with existing and easily sourced hardware at low bandwidth, making it malleable to&nbsp;clinical settings worldwide.</p>
<p style="font-size: 14px;">The technology complies with HIPAA, GDPR, and local data security&nbsp;and privacy regulations.</p>
<h5 style="font-size: 14px;"><strong style="font-size: 14px;">Proximie in practice</strong></h5>
<p style="font-size: 14px;">James Porter, M.D., is the director of surgical robotics at Swedish Medical Center at Providence St. Joseph Health in Seattle. As a robotic urologic oncologist and robotic surgery specialist, Porter treats and resections prostate, kidney and other urologic cancers. He also teaches robotic surgical techniques internationally and locally.</p>
<p style="font-size: 14px;">Porter used to travel once a month to provide surgical instruction outside the U.S. and speak at symposia. COVID prevented Porter from continuing this routine.</p>
<p style="font-size: 14px;">“Surgical education needed to continue despite the travel restrictions. Since I spend most of my time in the OR, I have many opportunities to collaborate with surgeons and teach the latest techniques in urologic robotics. This is where Proximie benefits me the most,” says Porter.</p>
<p style="font-size: 14px;">Porter reaches out through the web app to guide and mentor geographically dispersed surgeons. He assists the clinicians in their first experiences with complex new procedures and invites them into his OR so they can watch him operate. “It’s very convenient for me and my colleagues who don’t want to travel,” says Porter.</p>
<p style="font-size: 14px;">The technology unites health care practitioners in R&amp;D labs to test and develop surgical robotics technologies and products. “Proximie allows multiple surgeons into a lab for collaboration and troubleshooting robotic devices,” says Porter.</p>
<p style="font-size: 14px;">Patients benefit from the experience their clinicians gain through Proximie.</p>
<p style="font-size: 14px;">“It is easy to get siloed in surgery and do what you learned 20 years ago and never change or improve. Interaction with other surgeons provides the foundation for improvement,” says Porter. The Proximie web application supports the work/life balance that Porter prefers. “Less travel means less time on a plane and more time at home,” he says.</p>
<p style="font-size: 14px;">Porter appreciates the seamless two-way communication he can have with the technology. “There is very little to no latency, which means I never talk over the other surgeons,” he says. “The telestration is very robust, with many options and features to get the details of the surgery to the other participants. The ease of setup is also nice,” Porter says.</p>
<p style="font-size: 14px;"><strong style="font-size: 14px;">For more information</strong></p>
<p style="font-size: 14px;">Proximie is a subscription- based software solution. Contact Proximie at proximie.com/contact/ or request a demo at&nbsp;<a href="https://www.proximie.com/%20request-demo/" target="_blank" rel="noopener">proximie.com/request-demo</a>. •</p>


Proximie bridges the geographic gaps between surgical specialists and remote clinicians.

The future of surgeries

<p><nav aria-label="breadcrumbs" class="rank-math-breadcrumb"><p><span class="last">Melanoma management</span></p></nav><br />
<img loading="lazy" decoding="async" src="https://bpplplayground.wpengine.com/wp-content/uploads/2023/09/Tech-Notes-16x9-1.jpg" sizes="(max-width: 800px) 100vw, 800px" srcset="https://bpplplayground.wpengine.com/wp-content/uploads/2023/09/Tech-Notes-16x9-1.jpg 1024w, https://bpplplayground.wpengine.com/wp-content/uploads/2023/09/Tech-Notes-16x9-1.jpg 300w, https://bpplplayground.wpengine.com/wp-content/uploads/2023/09/Tech-Notes-16x9-1.jpg 768w, https://bpplplayground.wpengine.com/wp-content/uploads/2023/09/Tech-Notes-16x9-1.jpg 1536w, https://bpplplayground.wpengine.com/wp-content/uploads/2023/09/Tech-Notes-16x9-1.jpg 2048w" alt="" width="800" height="450"></p>
<p style="font-variant-ligatures: normal; font-variant-caps: normal; font-style: normal;"><em>Gene expression profile test leverages the activity of 31 genes for precise risk assessment of melanomas and melanoma management</em></p>
<p style="font-size: 14px;">PHYSICIANS RELY ON PATIENT CLINICAL DATA AND TUMOR PATHOLOGY FEATURES to predict the course of melanoma management in individual patients. But melanomas are unwieldy, recurring and progressing in the face of careful prognoses and management decisions. DecisionDx-Melanoma targets precise risk assessments for melanomas for&nbsp;physician and patient peace of mind.</p>
<p style="font-size: 14px;">DecisionDx-Melanoma is a gene expression profile (GEP) test that assesses the risk of recurrence of melanoma for patients diagnosed with early-stage melanoma, says Derek Maetzold, CEO of Castle Biosciences, the DecisionDx-Melanoma prognostics vendor.</p>
<p style="font-size: 14px;">According to Maetzold, DecisionDx-Melanoma&nbsp;uses patient tumor biology to predict the 5-year risk of cutaneous melanoma metastasis or recurrence independent of traditional staging factors. The test, which also predicts metastasis to the sentinel lymph node, is designed for patients with a stage I, ii or iii invasive melanoma diagnosis.</p>
<h2 style="font-size: 14px;"><strong style="font-size: 14px;">How it works</strong></h2>
<p style="font-size: 14px;">DecisionDx-Melanoma works by measuring gene activity in the patient for 31 genes correlating with the progression of the melanoma. DecisionDx-Melanoma classifies melanoma results using these traditional class designations:</p>
<p style="font-size: 14px;">• Class 1a: The lowest risk of recurrence/ metastasis within five years</p>
<p style="font-size: 14px;">• Class 1b/2a: An increased risk of recurrence/ metastasis within five years</p>
<p style="font-size: 14px;">• Class 2b: The highest risk of recurrence/ metastasis within five years</p>
<p style="font-size: 14px;">Patterns in the gene expressions in skin tumors serve as powerful indicators of skin biology and whether a confirmed tumor is likely to remain inert or grow aggressively, according to Maetzold. “We believe that assessing these gene expression patterns could help us improve the risk predictions that physicians make when incorporated with other tools at hand,” he says.</p>
<h2 style="font-size: 14px;"><strong style="font-size: 14px;">DecisionDx-Melanoma in practice</strong></h2>
<p style="font-size: 14px;">J. Michael Guenther, M.D., is a surgical oncologist at St. Elizabeth Edgewood Hospital in Englewood, Kentucky. Guenther practices oncology for pancreatic, stomach, breast and skin cancers, mainly focusing on melanomas and breast cancers.</p>
<p style="font-size: 14px;">Guenther sees patients with various stages of melanomas that may require surgical intervention. It can be challenging to categorize individual skin tumors in stages I through IV due to factors such as tumor depth, location and the likelihood of spread or return.</p>
<p style="font-size: 14px;">Before adopting the DecisionDx- Melanoma test, Guenther weighed the patient’s available clinical data such as age, sun exposure and whether they use sunscreen. He considered the pathological features of the tumor, such as ulceration and the depth of invasion of the tumor into the skin. He read the family medical history relative to cancer.</p>
<p style="font-size: 14px;">His assessment process has changed since then.</p>
<p style="font-size: 14px;">“When I see a new patient presenting with a confirmed melanoma, I order DecisionDx- Melanoma,” Guenther says. The test uses a small biopsy available from the original melanoma that the physician used to diagnose it. Guenther considers the test results and whether the tumor’s gene expression suggests a high or low risk of recurrence or spread. He looks at the usual clinical and pathological information as well and combines the data to synthesize an overall risk level for the patient.</p>
<p style="font-size: 14px;">The test mitigates more than risk; it also releases patient anxiety surrounding their diagnosis. According to Guenther, patients are often convinced that their melanoma will return. If DecisionDx-Melanoma confirms a high risk of recurrence, Guenther offers intensive follow-up. “When patients hear that, they’re less frightened and relieved to know that their physician will be consistently checking in on them,” Guenther says.</p>
<p style="font-size: 14px;">According to Guenther, when the test confirms a low risk, it’s life-altering for patients to know that their melanoma is unlikely to spread or recur.</p>
<p style="font-size: 14px;">“Either way, most patients want me to use DecisionDx-Melanoma when they hear about how it works. They are incredibly grateful to have appropriate management as a result,” he says.</p>
<p style="font-size: 14px;">Guenther claims professional benefits from the prognostic tool. “After I learned about DecisionDx- Melanoma,” he says, “I laid awake staring at the ceiling, wondering if I’d given incorrect recommendations for patient management before the test’s development. DecisionDx-Melanoma is so incredibly valuable. Since melanoma is such a heterogeneous disease, the test truly helps me decide what to do!”</p>
<p style="font-size: 14px;">When asked about his favorite feature in the test, Guenther claims its accuracy. “When you see a low-risk result, it means that there is a 99.6% chance at five years that a patient won’t have melanoma again,” Guenther says. Castle Biosciences’ Maetzold says that there have been studies of DecisionDx-Melanoma in 6,000 patient samples.</p>
<p style="font-size: 14px;"><a style="font-size: 14px;" href="https://castletestinfo.com/" target="_blank" rel="noopener">Castle Biosciences</a> DecisionDx- Melanoma is a medical test billed to the patient’s insurance provider, Medicare and the U.S. Department of Veterans Affairs. Castle Biosciences sponsors a patient assistance program. For more information, visit castletestinfo.com and look for the section on DecisionDx-Melanoma.</p>
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Melanoma management

<p>Not all physicians are happy with their electronic health records software. Let’s see whether the ModMed’s EMA (electronic medical assistant) otolaryngology EHR software measures up.</p>
<h4>The ModMed EHR for otolaryngology</h4>
<p>According to the ModMed <a href="https://www.modmed.com/otolaryngology/">website</a>, the EMA EHR system for otolaryngology is a cloud-based software suite. The integrated suite combines EHR software with applications for practice management, analytics, business operations and patient interactions. The suite also automates tasks for the practicing physician.</p>
<p>According to David Lehman, M.D., senior medical director of otolaryngology at ModMed, the otolaryngology EHR adapts to each physician’s unique style of practice and remembers their preferences and commonly used workflows to make it more efficient and easier to use.</p>
<p>The application integrates medical coding and reporting with automatic ENT ICD-10 and E&amp;M code suggestions. The ModMed system bases the code suggestions on the 2021 E&amp;M guidelines and the provider’s documentation.</p>
<p>The software suite includes analytics tools for tracking and benchmarking clinical, financial and operational performance. ModMed intends the tools to identify practice inefficiencies in the areas above and explore population trends, care utilization and quality measures, according to Lehman.</p>
<p>The business operations application enables physicians to offload their revenue cycle processes to ModMed’s billing specialist team. Billing experts address support issues, financial transparency and revenue cycle acceleration for the medical practice.</p>
<p>“Because it is cloud-based and easily accessible on an iPad, ModMed allows ENTs to easily get their patients involved in the process of documentation and patient education. It also offers a patient portal, automated appointment reminders and patient surveys,” Lehman says.</p>
<h4>ModMed performance in practice</h4>
<p>Jeff Goodell, D.O., is a board-certified otolaryngology and otolaryngic allergy physician who practices at ENT &amp; Allergy in Midwest City, Oklahoma. Lara Smith, doctor of audiology, works with Goodell, seeing patients with hearing loss.</p>
<p>“We see patients of all ages for general ear, nose and throat problems, as well as for allergy symptoms,” says Goodell. Goodell uses the ModMed’s EHR for otolaryngology in his practice.</p>
<p>Goodell says his first EHR was generic and required multiple manual steps. He invested time and energy in building templates for the suite that were specific to his practice, but the flow was off, and generating notes from templates was cumbersome, he says.</p>
<p>He found the ModMed EHR suite while looking for an iPad (or Mac) compatible EHR built for ENT practices. It had to support efficient charting and effective tracking and reporting on their MIPS measures while connecting seamlessly with their practice management system. “For those reasons, I chose the all-in-one ENT software suite [from ModMed] that includes the EMA EHR and Practice Management system,” says Goodell.</p>
<p>“The system allows us to schedule patients, direct workflow with each patient, record and maintain our medical charting, and manage typical billing and collection activities,” says Goodell.</p>
<p>Goodell has seen a better work/life balance, too. “I no longer spend hours each night at home charting on work that was done during the day,” he says.</p>
<p>Goodell’s favorite features from the software suite include mobility with utility and current and consistent medical coding suggestions. “I like the iPhone application, which helps with patient care while on the road. Also, the suggested medical coding EMA provides is consistent with the new E&amp;M coding requirements and has been very helpful,” Goodell says.</p>
<p>Goodell’s wish list of features for future iterations of ModMed’s ENT EHR includes the ability to link a message to a patient attachment directly without the manual steps. “This would be easier than having to open a message from a patient, go into that same patient’s chart and look for the attachment,” he says.</p>
<h4>Pricing</h4>
<p>According to Lehman, pricing for ModMed’s ENT EHR suite varies based on several factors.</p>
<p>To learn more and get the software suite, see <a href="https://www.modmed.com/otolaryngology/">ModMed Otolaryngology</a>.</p>


Electronic Health Records software

<p>Surgeons repairing ventral (abdominal) hernias and abdominal wall defects use synthetic, natural (tissue-based) and hybrid mesh reinforcements to bridge, reinforce and stabilize the hernia repairs.</p>
<p>But surgical mesh issues add risks such as foreign body rejection and mesh degradation.</p>
<p>Though permanent synthetic mesh is durable, the immune system can reject the foreign body material. Symptoms can include organ perforation, bowel obstruction and chronic pain.</p>
<p>In addition, the surgeon may have to remove the mesh and resection the surrounding tissues in response to complications. The resections can diminish the remaining abdominal wall.</p>
<p>Natural mesh products aren’t perfect either. While the biologic (tissue-based) reinforcements meet the demands that immune responses place on foreign bodies, these mesh technologies are not durable.</p>
<p>Resorbable synthetic mesh is another choice for hernia repairs. Resorbable synthetics use polymers that offer reinforcement, then resorb over time, leaving no trace of the foreign bodies. But the dissipating materials reduce the reinforcement.</p>
<h4>OviTex provides a hybrid solution</h4>
<p><img loading="lazy" decoding="async" src="https://bpplplayground.wpengine.com/wp-content/uploads/2023/08/Screen-Shot-2022-02-23-at-2.37.45-PM-2.png" alt="TELA Bio's OviTex Reinforced Tissue Matrix" width="400" height="246"></p>
<p><a href="https://www.telabio.com">TELA Bio</a> sought to drop the weaknesses of earlier surgical mesh products with its OviTex line of mesh reinforcements.</p>
<p>The TELA Bio OviTex Reinforced Tissue Matrix (RTM) mesh products offer a unique hybrid using synthetics and biologics. The product comprises layers of ovine rumen (sheep forestomach). According to Paul Talmo, principal of strategy at TELA Bio, OviTex is ideal for hernia and stomach wall applications because of its handling, stability and biomimetic characteristics.</p>
<p>OviTex binds the ovine rumen with a polymer suture interwoven through the layers for strength and durability, Talmo says. The OviTex material embroiders the ovine rumen using polymer sutures, which make up only 5% of the reinforcement device’s weight.</p>
<p>According to Talmo, the ovine tissue buffers the body against localized inflammation and foreign body responses to the minimal polymers while the sutures offer durability. In addition, OviTex comes with permanent or resorbable sutures, so the surgeon and the patient have options for the procedure.</p>
<h4>What OviTex does for patients and physicians</h4>
<p>Paul Szotek, M.D., is medical director of the Indiana Hernia Center. Office visits for Szotek’s patients include pre-surgical counseling with shared decisions on hernial procedures and the opportunity to use OviTex mesh reinforcements.</p>
<p>Before OviTex, Szotek used a biologic mesh material. He sought a mesh reinforcement product with durability, infection resistance, and a low residual foreign body material when he found TELA Bio’s OviTex.</p>
<p>Szotek offers patients a choice of traditional mesh repair or a Reinforced Biologic Repair (ReBAR) using a mix of tissue repair and OviTex reinforced biologic.</p>
<p>“Once they decide to have surgery and decide they want the ReBAR repair, we either implant OviTex using the DaVinci robot (&gt;60% of cases) or with an open incision based on the technical aspects and the type of hernia,” says Szotek.</p>
<p>According to Szotek, OviTex is durable and clears any resulting infections.</p>
<h4>Physician wish list</h4>
<p>Among Szotek’s wish list of future enhancements to OviTex is a gripping technology on the mesh to enhance lateral friction to prevent sliding. He prefers a range of LPR mesh sizes for laparoscopic and robotic surgeries.</p>
<p>According to Talmo, TELA Bio plans to provide more products tailored to specific soft-tissue applications. Its OviTex LPR, intended to improve the mesh product’s handling abilities in less invasive laparoscopic and robotic hernia procedures, is an example of a tailored surgical mesh reinforcement solution.</p>
<h4>Where to find</h4>
<p>Look for TELA Bio surgical mesh products at <a href="https://www.telabio.com">telabio.com</a>.</p>


Tech notes covering the DrChrono mobile EHR app

Surgical mesh issues

<p><img loading="lazy" decoding="async" src="https://bpplplayground.wpengine.com/wp-content/uploads/2023/08/TechNotes.jpeg" alt="surgeons operating on a patient" width="782" height="440"></p>
<p>In the 1950s, “the surgical microscope entered the neurosurgical operating room … at the University of Southern California,” notes a 2009 article in the Journal of Neurosurgery. More than 60 years later, the operating microscope is the 2-D gold standard for brain and spine procedures.</p>
<p>The 2-D operating microscope for microneurosurgery assists surgeons with enhanced perception of the surgical field. The technology typically includes a second site where a medical student or operating team member can peer into the brain.</p>
<p>According to Dr. Michael Schulder, M.D., a neurosurgeon with North Shore University Hospital in Manhasset, N.Y., the view from the additional site is almost as good as the surgeon’s.</p>
<p>But while the 2-D microscope is impressive, the new 3-D robotic exoscopes for exoscope neurosurgery offer stiff competition.</p>
<p>In the Journal of the Korean Neurosurgical Society in 2017, Kenichi Nishiyama, M.D., Ph.D., describes 3-D exoscopes as this: “A high-definition video telescope and operating monitor system for performing microsurgery…(that) enables surgeons to complete the operation by visualizing magnified images on a display. The strong points of an exoscope are the broad field of view and deep focus. It minimizes the need for repositioning and refocusing the scope during the procedure.”</p>
<p>The <a href="https://www.synaptivemedical.com/products/modus-v/">Modus V 3D robotic digital exoscope from Synaptive Medical</a> offers one example of the new medical technology’s range of abilities.</p>
<h4>The technology up close</h4>
<p>According to Kyle D’Arcey, director of product management for Synaptive Medical, the Modus V 3D robotic exoscope moves in sync with the procedure, tracking a co-axial view of the surgical instruments.</p>
<p>The exoscope’s advanced optics and video processing allow it to render high-quality HD video images of the surgical field on a computer monitor. The exoscopic visualization gives surgeons depth perception and surgical views with a 12.5-times optical zoom.</p>
<p>The Modus V proves easy on the surgeon’s spine, enabling them to operate heads-up, viewing the monitor. It also uses voice activation to control all system settings, including motion.</p>
<h4>Comparing the Modus V with 2-D Operating Microscopes</h4>
<p>Michael Schulder, M.D., is vice chair of neurosurgery and director of the Brain Tumor Center at North Shore University Hospital. On August 6, 2020, Schulder was reported as the first surgeon on Long Island to use Synaptive’s Modus V 3-D exoscope to remove a brain tumor.</p>
<p>As Schulder describes it, the surgeon and anyone within the computer monitor’s range can see what the exoscope sees in three dimensions in high resolution.</p>
<p>“The surgical staff and anesthesiologists all see the same thing. Your scrub nurse, your circulating nurse, they’re all much more a part of the procedure as a result of using the exoscope,” says Schulder. There are advantages for medical education, says Schulder; residents, surgeons, medical students and trainees can see what’s happening.</p>
<p>The Modus V 3D images serve as safeguards. According to Schulder, the Modus V helps ensure that the assisting surgeon’s hands aren’t going astray, so the surgeon doesn’t have to constantly tell them to be careful. It’s much easier to avoid reaching too deeply when both surgeons see the procedure in three dimensions, Schulder adds.</p>
<p>The Modus V makes Schulder’s work easier. “Ergonomically, you can stand or sit and look straight ahead during the operation, viewing everything on the monitor. It’s a much more natural, comfortable position, and you’re not constrained by the visual requirements of the operating microscope,” says Schulder.</p>
<p>Schulder suggests some qualitative observations of the Modus V:</p>
<p>You’ll probably have fewer hemostasis problems, he notes, and less risk of hematoma formation because you have two people working together. The surgery could be less invasive as surgeons can look down toward the targets in the brain and operate without having to have broad exposure to the brain.</p>
<p>Good nerve tracing makes for excellent surgical planning. The synaptic scope and the integrated stereotactic navigation with geographical white matter tracking are pretty enabling, according to Schulder.</p>
<p>“You can trace out brain nerve fibers and plan a surgical approach that avoids injury to critical nerve pathways for control, sensation or efficient speech,” he says.</p>
<h4>Favorite features and wish list</h4>
<p>According to Schulder, voice activation is a favorite Modus V feature because it lets the surgeon guide the movements of the exoscope using straightforward and intuitive voice commands. The surgeon can zoom in and out and change the lighting while keeping their hands in the surgical field, says Schulder.</p>
<p>Schulder hopes to see advances in the Modus V related to surgical visualization technology. Surgical visualization injects fluorescent substances into the bloodstream, highlighting tumors, cerebral spinal fluids, and blood vessels. Successful surgical microscopes take advantage of surgical visualization. Modus V needs this functionality, according to Schulder.</p>
<h4>For more information</h4>
<p>See the Modus V <a href="https://www.synaptivemedical.com/products/modus-v/">product page</a> for more information. Use the contact page to reach the vendor for pricing. According to D’Arcey, the Modus V price is comparable with that of a conventional surgical microscope.</p>


Tech Notes Modus 3D robotic exoscope for microneurosurgery

Exoscope neurosurgery

<p>Physicians use stethoscopes to collect heart sounds from patients in their offices. But what about remote patients?</p>
<p>The Eko DUO ECG + Digital Stethoscope &#8211; or EKO digital stethoscope ECG &#8211;&nbsp; is an intelligent stethoscope that closes the distance by streaming heart sound and ECG tracing data across the internet while enabling high-fidelity auscultation sounds and data analysis.</p>
<h4>About the technology</h4>
<p>The <a href="https://www.ekohealth.com/product/eko-duo-ecg-digital-stethoscope">Eko DUO ECG + Digital Stethoscope</a> lets physicians screen patients in the office, across the country or around the world. With this technology, you can listen to heart sounds and take ECG tracings at rural clinics and nursing homes too, says Bryan Humbarger, senior vice president at Eko. Patients can also collect and stream heart sound and ECG data from home.</p>
<p>The Eko telehealth platform combines video, high-fidelity auscultation sounds and ECG for telehealth visits, enabling virtual visits and screenings through a live stream. The platform integrates with telemedicine and home care settings, using embedded video conferencing or a health system’s video platform. The Eko platform’s dashboard secures access to patient information and recordings.</p>
<p>The appropriately named Digital Stethoscope digitizes the exam, so physicians can access machine-learning algorithms and AI analysis tools to detect heart disease.</p>
<p>“The Eko DUO analyzes heart sound and ECG data to detect murmurs, atrial fibrillation and hemodynamic parameters indicative of heart disease,” Humbarger says.</p>
<p>For expanded utility, the Eko DUO integrates with the CORE 2 Digital Attachment to stream sounds to Bluetooth devices for contactless screening while adding amplification, active noise cancellation and wireless functionality. Using the Eko app or dashboard, physicians can record, save, share or stream stethoscope sounds and waveform visuals for further consultation.</p>
<p>Speaking of apps, physicians use Eko’s mobile and web software for iOS, Android and Windows to wirelessly pair with the Eko CORE 2 Digital Attachment and DUO and to manage sounds and tracings.</p>
<h4>Using the intelligent stethoscope</h4>
<p>Terry Grossman, M.D., founder of Grossman Wellness Center in Denver, is an authority on anti-aging, longevity and preventive medicine.</p>
<p>“Before COVID, my office visit mix was 80% in-office and 20% telehealth using a video conferencing platform,” Grossman says. “I was not able to auscultate the chest or abdomen in the telehealth cases.”</p>
<p>Now with the Eko DUO, Grossman can care for local, remote and even foreign patients. “Eighty percent of visits are now videoconference telehealth, and 20% are in person,” he says. “I use the Eko DUO to listen to heart and breath sounds as part of routine checkups or for specific complaints, particularly around COVID.”</p>
<figure id="attachment_19947" aria-describedby="caption-attachment-19947" style="width: 164px" class="wp-caption aligncenter"><img loading="lazy" decoding="async" src="https://bpplplayground.wpengine.com/wp-content/uploads/2023/08/Stethoscope-app.png" alt="smartphone app showing heart rhythm" width="164" height="300"><figcaption id="caption-attachment-19947" class="wp-caption-text">The Eko CORE 2 Digital Attachment streams sounds to Bluetooth devices and adds amplification and active noise cancellation to the Eko DUO.</figcaption></figure>
<h4>Small device, big changes</h4>
<p>Treatment sans travel is a significant relief for patients. The Eko DUO has also enhanced Grossman’s quality of work. “I make sure that all of my patients have a pulse oximeter in their home so they can measure their oxygen levels. With the Eko DUO in their home, I can hear their lungs and make an accurate assessment, so they don’t have to go to an ER or urgent care,” says Grossman.</p>
<h4>Favorite features, wish list</h4>
<p>“The augmented sound available on the Eko DUO is better than my high-end cardiology stethoscope,” Grossman says. “I heard a murmur I never heard before. Then I looked at the Eko software, and it said, ‘murmur.’ The AI is quite good.”</p>
<p>As for future features on the Eko DUO, Grossman would find it helpful to check blood pressure, visualize the tympanic membrane, look at the pharynx, and check the Sa02 levels using the Eko DUO. “These capabilities would allow a complete physical evaluation of the patient,” says Grossman.</p>
<h4>How to get</h4>
<p>The Eko DUO ECG + Digital Stethoscope retails for $349. The Eko CORE 2 Digital Attachment retails for $199. Purchase online at <a href="https://shop.ekohealth.com">shop.ekohealth.com</a>.</p>


EKO digital stethoscope ECG

<p>Grand View Research valued the global EHR market at $27.67 billion in 2019 and expected the market to grow at a compound annual growth rate of 4.8% through 2027. DrChrono is one popular solution in the EHR market.</p>
<p>The DrChrono mobile EHR app for iPad, iPhone and Apple Watch enables EHR services on-the-go for patients. So here&#8217;s the Mobile EHR review: DrChrono:</p>
<h4>What it offers physicians</h4>
<p>According to Daniel Kivatinos, COO and cofounder of DrChrono, the app automates administrative tasks so doctors can focus on patient care. It enables physicians to provide informed care using a personalized, interactive interface.</p>
<p>DrChrono guides physicians through the EHR to free drawing, medical speech-to-text, lab orders and e-prescribing capabilities right from the chart, using smart shortcuts.</p>
<p>The mobile EHR app leverages professional cameras installed on the Apple iPad, photographing and documenting the patient’s condition in the medical note.</p>
<figure id="attachment_19831" aria-describedby="caption-attachment-19831" style="width: 864px" class="wp-caption aligncenter"><img loading="lazy" decoding="async" src="https://bpplplayground.wpengine.com/wp-content/uploads/2023/08/TechNotes.png" alt="DrChronos app on a cellphone" width="864" height="810"><figcaption id="caption-attachment-19831" class="wp-caption-text">iTunes: apps.apple.com/us/app/drchrono-ehr-emr/id369191782</figcaption></figure>
<p>DrChrono practice management automates a practical workflow for clinician-staff interactions, such as scheduling and billing. DrChrono enables its OnPatient Portal for secure communications between patients and physicians.</p>
<p>“Providers externalize DrChrono’s calendar tool to their website, making it easier for patients to schedule appointments without signing into the OnPatient platform,” says Kivatinos.</p>
<p>Integrated medical billing rids duplicate data entries and human error. The app also manages revenue cycles, confirms patient eligibility, collects copays, codes and tracks claims, and collects payments while staying on top of denied claims.</p>
<p>DrChrono for the iPhone is fully featured, documenting rounds, securing patient notes, and billing insurances on the fly. DrChrono for the Apple Watch presents physicians with appointments, refill requests and lab results and enables interoffice chat with colleagues and patients in a single interface.</p>
<p>A new telehealth Video Visit integrated app enables a full complement of telehealth options, including inbound requests to provide virtual care from inside the EHR.</p>
<p>The Video Visits technology is fully compliant with HIPAA regulations. Through Video Visit, physicians set online appointments and send automated emails to patients with no additional software or set-up requirements.</p>
<p>Bill J. Metaxas, DPM, CEO of the San Mateo Podiatry Group, says that, before adopting DrChrono, he and his team were frustrated by a legacy EHR that lacked mobility, customizations and automation.</p>
<p>That’s when Metaxas and his team found DrChrono. “Our doctors and clinical team love it for its intuitive design, high functionality and speed,” he says. As for administrative overhead, DrChrono simplifies billing by enabling coding and billing automation.</p>
<p>Metaxas’s wish list for future versions of DrChrono includes better tracking and reporting for referral sources, patient callback lists and future practice capacity.</p>
<p>He would like to see DrChrono make custom demographics mandatory in the OnPatient Portal and would welcome better tracking for outbound referrals and results, so he knows the loop is closed.</p>
<h4>How to get the app</h4>
<p>DrChrono is available on the App Store. Pricing starts at $250 per month. Visit <a href="https://www.drchrono.com/ehr-pricing-quote/">drchrono.com</a> for more.</p>


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Related Content About Tech Notes

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Mobile EHR review: DrChrono

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Virtual Career Fairs

New England